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General NPI Number Information
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NPI Number | 1174783617
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Entity Type | Organization
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Legal Business Name | MARK V WALTERS DC PC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 316 W MOUNT VERNON BLVD
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City | MOUNT VERNON
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State | MO
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Zip | 65712-1940
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Country | US
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Telephone | 417-461-1155
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Fax | 417-461-1155
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Provider Business Mailing Address
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Address Line | 316 W MOUNT VERNON BLVD
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City | MOUNT VERNON
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State | MO
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Zip | 65712-1940
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Country | US
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Telephone | 417-461-1155
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Fax | 417-461-1155
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. MARK VINCENT WALTERS
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Credential | DC
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Telephone | 417-461-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 006467
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 006467
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License Number State | MO
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